Intervention Review

Electropalatography for articulation disorders associated with cleft palate

  1. Alice S-Y Lee1,*,
  2. James Law2,
  3. Fiona E. Gibbon1

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 8 APR 2008

DOI: 10.1002/14651858.CD006854.pub2

How to Cite

Lee ASY, Law J, Gibbon FE. Electropalatography for articulation disorders associated with cleft palate. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006854. DOI: 10.1002/14651858.CD006854.pub2.

Author Information

  1. 1

    University College Cork, Department of Speech and Hearing Sciences, Cork, Ireland

  2. 2

    Queen Margaret University, Centre for Integrated Healthcare Research, Edinburgh, Scotland, UK

*Alice S-Y Lee, Department of Speech and Hearing Sciences, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland. a.lee@ucc.ie.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 JUL 2009

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cleft palate is the most common congenital deformity of the face. It could affect speech acquisition, resulting in articulation errors that could persist into adulthood. Electropalatography (EPG) has been used in speech therapy with individuals who have articulation problems that are unresponsive to "standard treatment" procedures.

Objectives

To determine the effectiveness of speech intervention using electropalatography (EPG) for treating articulation errors in individuals with repaired cleft palate.

Search methods

The following databases were searched: CENTRAL 2008 (Issue1), MEDLINE 1966 to March 2008, EMBASE 1974 to March 2008, CINAHL 1982 to March 2008, PsycINFO 1967 to March 2008 and eight other databases. We handsearched Clinical Linguistics and Phonetics (1987 to 2008, Issue 2), Cleft Palate Journal/ Cleft Palate-Craniofacial Journal (1980 to 2008, Issue 1), and the International Journal of Language and Communication Disorders (1980 to 2008, Issue 1). We searched the EPG bibliography (Gibbon 2007). We reviewed reference lists of relevant articles and approached researchers to identify other possible published and unpublished studies.

Selection criteria

Randomised controlled studies comparing EPG intervention to no treatment, delayed treatment, "standard treatment", or alternative treatment techniques for managing articulation problems associated with cleft palate in children or adults.

Data collection and analysis

One author searched the titles and abstracts and assessed trial quality. A second author checked judgements; disagreement was resolved through discussion. Three authors were available to examine any potential trials for possible inclusion in the review.

Main results

One trial using parallel design met the inclusion criteria of this review; no meta-analysis was performed. The study reported that fewer therapy sessions were needed to achieve the treatment goals for the EPG therapy and frication display method (N = 2), followed by EPG therapy (N = 2) and "standard treatment" (N = 2).

Authors' conclusions

The included trial was a small-scaled study and there were serious limitations in the design and methodology (e.g. allocation concealment was unclear, blinding of outcome assessor(s) was not ensured, few quantitative outcome measures were used, and the results were not reported as planned). Therefore, the current evidence supporting the efficacy of EPG is not strong and there remains a need for high-quality randomised controlled trials to be undertaken in this area.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Electropalatography for articulation disorders associated with cleft palate

A cleft palate means that during the early stages of pregnancy, the baby’s roof of the mouth does not join in the normal way. The lip is sometimes cleft as well as the palate. Children who are born with a cleft lip or palate usually have corrective surgery during the first few years of life. Nowadays, surgery is so good that there are few long term consequences.

However, some children with repaired cleft palate can have difficulties with speech as they get older. One type of speech difficulty affects consonants formed by the tongue in the mouth, such as /t/, /d/, /s/. This makes words like “toe”, “door” and “sun” sound distorted or even unrecognisable to listeners. These consonants can be difficult to correct, even by experienced speech and language therapists. Any long term speech difficulties are likely to have a negative effect on children’s social, psychological and educational development and future prospects.

One technique that may help to correct these abnormal articulations is electropalatography or EPG. EPG is a computer-based technique that can display the tongue's contact with the hard palate (roof of the mouth) during speech. It involves the child wearing an adapted dental plate, with sensors on the surface. When the tongue contacts the sensors, distinctive patterns for consonants are displayed on a computer screen. The patterns can be used in speech therapy to provide visual feedback so that children can learn normal patterns for consonants they find difficult.

It is not known whether EPG benefits children with cleft palate. Such information is important for speech and language therapists who may want to use the technique in their clinical practice. The review reveals that at present there are no high quality (randomised controlled trial) studies in this field to enable conclusions to be drawn about the efficacy of treatment using EPG for children with cleft palate.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於顎裂 (cleft palate) 相關的構音障礙 (articulation disorder) ,電子硬顎圖 (electropalatography) 的運用

顎裂是臉部最常見的先天性畸形。它可以影響語言的習得,造成可能持續到成人的構音錯誤。針對那些有構音問題,但對於傳統標準治療方式缺乏反應的病人,電子硬顎圖 (EPG) 曾被運用在語言治療中。

目標

評估使用電子硬顎圖,來治療有顎裂,但已修復過的病人之構音問題,此種語言治療介入的效果。

搜尋策略

搜尋下列的資料庫: CENTRAL 2008年 (Issuel) ,MEDLINE 1966年至2008年3月,EMBASE 1974年至2008年3月,CINAHL 1982年至2008年3月,PsycINFO 1967年至2008年3月,和其餘八個資料庫。我們並手動搜尋Clinical Linguistics and Phonetics (1987年至2008年,Issue 2) ,Cleft Palate Journal/Cleft PalateCraniofacial Journal (1980年至2008年,Issue 1) ,和the Internal Journal of Language and Communication Disorders (1980年至2008年,Issue 1) 。我們搜尋了the EPG bibliography (Gibbon 2007) 。我們回顧了相關文章的參考文獻,以找出其他可能相關的研究,不論是可能已發表或尚未發表的。

選擇標準

以隨機對照試驗 (randomised controlled study) ,針對對有顎裂造成之構音問題的孩童或成人,以EPG介入方式,和沒有接受治療、延遲接受治療、接受標準治療,或其他替代治療技術之效果比較。

資料收集與分析

一位作者搜尋標題和摘要,評估試驗的品質。第二位作者檢視判斷。不一致的地方藉由討論來解決。三位作者都能夠檢視任何可能文獻,以便納入此回顧的可能性。

主要結論

一個使用平行設計 (parallel design) 的試驗有達到這篇回顧的納入標準;但並未執行統合分析 (metaanalysis) 。這篇試驗報告指出,在達到治療目標所需的治療次數方面,接受EPG治療和frication display method的所需次數較少 (N = 2) ;隨之其後的為EPG治療 (N = 2) 和常規治療 (N = 2) 。

作者結論

這個被納入的試驗是小型試驗,且有明顯的設計和方法學限制 (舉例說明,沒有清楚的分組隱匿 (allocation concealment) 、無法確定預後評估者是否維持盲者 (blinding) 、只運用少數量化的預後量測、結果並未如原本計劃般所報告) 。因此,目前能夠支持EPG治療功效的證據仍不夠充分,需要更多針對這個領域設計的高品質隨機對照試驗。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

顎裂指的是,在懷孕的初期,寶寶嘴部的頂部並未依正常程序合在一起。唇部有時也和顎部一樣裂開。有顎裂或唇裂的孩童通常會在早年接受矯正性手術。目前,由於手術技術的進步,通常長期的後遺症並不多。然而,某些修補後顎裂的孩童在長大的過程中,會出現語言困難。其中一種語言困難會影響嘴部舌頭行程的輔音,例如 ‘t’ 、 ‘d’ 、 ‘s’ 。這會造成像是 ‘toe’ 、 ‘door’ 、 ‘sun’ 等字的發音被扭曲,甚至對聽者而言難以辨識。這些輔音可能相當難矯正,即使是由有經驗的語言治療師來做也一樣。任何長期的語言困難都有可能對孩童的社交、心理和教育的發展、以及未來有負面的影響。其中一種用來協助矯正異常構音的技術是電子硬顎圖 (EPG) 。電子硬顎圖是一種倚靠電腦,可以顯示出舌頭和硬顎在說話時的接觸。它包括一個孩童戴著的,表面有感應器的適應性牙盤。當舌頭碰觸到感應器時,不同形式的輔音被顯示在電腦螢幕上。這些形式可以被運用在語言治療中,提供視覺上的回饋,孩童因此可以學習到他們感到困難的正常輔音形式。但是EPG是否對有顎裂的孩童有幫助並不清楚。然而這樣的資訊對語言治療師來說是重要的,因為他們在每天的臨床實務上可能希望用到這項技術。這篇回故呈現的是,到目前為止,在這個領域並沒有高品質 (隨機對照) 的試驗,來指出使用EPG對有顎裂的孩童治療是否有效果的結論。